Reliability of bimanual pelvic examinations performed in emergency departments
The Article: Close, R.J.H, et al. Reliability of bimanual pelvic examinations performed in emergency departments. Western Journal of Medicine. Oct 2001; 175:240-244.
The Idea: Evaluating the reliability or reproducibility of bimanual examinations performed by emergency physicians in the emergency department.
The Study: A prospective observational study of 186 female patients presenting with pelvic or abdominal symptoms requiring a bimanual pelvic exam. Each patient had a bimanual exam performed by two different examiners, one an attending physician and one a 3rd or 4th year resident. Four variables were evaluated upon examination: cervical motion tenderness, uterine tenderness, adnexal tenderness, and adnexal mass. For each variable, findings were defined by the physicians as “clinically significant”, “not clinically significant”, or “unsure” due to limitations such as obesity, pain, anxiety, or retroversion. Using their responses for each variable, the percentage of agreement and the percentage of positive agreement was calculated. Poor reliability was defined as a percentage of agreement of positive findings less than 50%.
The Findings: The authors found that the reliability of bimanual pelvic exams performed in the ED performed by emergency physicians is poor. The percentage of agreement ranged from 71-84% for all the variables and the percentage of positive agreement was low, ranging between 17-33%.
The Takeaway: Appreciate the limitations of the bimanual pelvic exam and use other information/findings in conjunction with the bimanual exam to make clinical decisions. As discussed amongst our residency, using ultrasound could confirm or reveal findings that are or are not found on bimanual exam.